Medication warnings
Certain veterinary medications for other conditions may seriously affect diabetic patients. This list is provided because some of these medications don't mention their side effects on diabetics in their literature. Many drugs used in veterinary medicine are also used in human medicine under a differently-trademarked name. Learning the human pharma name (if applicable) or generic name of the drug (same in veterinary & human medicine) can often give you additional information regarding possible side effects and how the drug may affect patients with diabetes. Human pharma drugs provide this information--for some reason, veterinary drugs don't always. If you are considering alternative or herbal medicine for your diabetic pet, see also Alternative medication warnings. Whenever medication is prescribed, knowing the following when you receive it can make things easier: * Name of the drug * Condition the drug is meant to treat * How the drug is to be given-orally, in the ear or eye, applied to the skin * When and how often it is to be used * What to do if you miss a dose * The effects expected from the drug * Possible side effects of the drug * Length of time to give the drug * If the drug has any special handling or storage requirements (Insulin, for example, is normally refrigerated) * If there are any problems that may be expected in giving the medication Warning: Can Be Fatal to Diabetics and Non-Diabetics Contraindicated: May complicate or even promote diabetes Urinary Incontinence Hormones These types of hormones, when prescribed for diabetics, can be "double problems". The progestin-type hormones themselves, by nature, raise blood glucose; use of them can also mean the body may begin producing excess growth hormones, which causes insulin resistance. Antiarrhythmics/Heart/High Blood Pressure Steroids-Approach with caution *Oral or injected steroids such as cortisol are known to raise blood sugar and even sometimes cause diabetes. Talk to your vet -- sometimes steroids are still the best (or only) treatment for a condition and can be compensated for with known diabetes. Inhaled steroids for asthma may be tolerated by diabetics better than oral or injected. Using steroids--orally, injected or even topically (applied to the skin as an ointment or cream)--can elevate blood glucose levels. During treatment and for a period after treatment with steroids ends, higher doses of insulin may be necessary. *More brand names for corticosteroids are : *'Prednisone' *'Decadron' *'Kenalog' One brand name for injectable prednisone (methylprednisolone ) is Depo-Medrol. There is another class of steroids in need of mention here. They are called anabolic steroids, and are related to the male sex hormone, testosterone. Their main uses are for medically supervised weight gain, inappetance, (most commonly Winstrol/Stanozolol), and in treatment of some forms of anemia and cancer. See the steroids page for more information. Many generic and brand name steroid medications, some with photo label links, are found on the Prescribed Steroids page. Warnings: May raise blood glucose levels Heartworm and flea/tick prevention *Heartworm and flea/tick prevention medications are known to produce temporary high blood glucose levels in some diabetic dogs. In the affected animals, glucose levels return to normal a few days after the medication is used--loss of control being temporary. Just as all diabetics are not troubled with post-prandial spikes or dawn phenomenon, not all diabetic pets react to these medications in this way. No pharmaceutical company's products of this type contain advisories regarding the temporary elevation of blood glucose. Heartworm is a global problem, with areas on all continents except Antarctica affected and is a disease that is far easier to prevent than to cure. It can affect both cats and dogs. Should your pet be affected by this, a talk with your vet is in order. Increasing insulin doses to counter this temporary situation may cause hypoglycemia once the systemic medication level has lowered. The phenomenon also does not mean your pet has ceased to respond to the insulin you currently use. Since there are no formal label warnings, he/she needs to be aware that there are temporary side effects for these drugs which apply to some diabetics. *The same is true for flea and tick removal or prevention products, both professional and over the counter; they are also capable of producing this unwanted effect after use in some diabetic animals. Other Medications Epinephrine, or adrenalin, is a hormone present in all of us; most medical literature refers to it simply as the "fight or flight" hormone. It is what gives one that "extra boost" when needed to either escape danger or stand one's ground; can also be referred to as a catecholamine. A common medical use of epinephrine is to combat severe allergic/asthmatic reactions. Many people with life-threatening reactions to things like bee stings, etc., are never without their EpiPen. It's a pre-loaded injection of epinephrine to be used in an emergency. When someone with diabetes needs treatment with epinephrine, it counters the effects of the insulin and hyperglycemia is the result. Also see below under diuretics/heart medications for some diuretics which can cause hyperglycemia. Warnings: May have other adverse side effects Antibiotics Our pets may be prescribed antibiotics for various reasons, such as a dental procedure or a urinary tract infection. *A common full-spectrum antibiotic given for dental procedures is Clavamox, which is available in both tablet and liquid form. The liquid form is sweet, but the sweetness is from an artificial sweetener and should not affect blood glucose. The pill can be crushed and added to wet food if the animal is difficult to pill. Some animals, like some humans, get diarrhea on antibiotics. This can be minimized by the concurrent administration of a probiotic like Culturelle, which is available at vitamin stores. Consult with your veterinarian on the appropriate amount of probotic for your animal. Some caregivers report higher blood glucose levels while their pet is on antibiotics. Sulfa drugs *Another class of drugs used to fight various infections are called Sulfa Drugs. They are often used similarly to antibiotics for this purpose. Sulfa drugs can cause hypoglycemia, even in those without diabetes. They are also capable of altering urine glucose test results. Diuretics/Heart/Hypertension Medications * Heart drug Digoxin and diuretic furosemide (both have many other brand names-table and links below), can interact with insulin. *Though its primary use is for treatment of diabetes, insulin is useful to both people and pets suffering from an overdose of potassium--too much of it in the blood. The medical term for this is hyperkalemia . Potassium ions enter the cells through glucose--insulin helps bring this life-saving change about. *'Furosemide'/'frusemide' and other diuretics shown in table below, belong to a class of directics known as loop diuretics. This type of medication can cause hyperglycemia for those with diabetes. Both digoxin and furosemide/'frusemide' drain potassium from the system, along with the excess fluids they are prescribed to eliminate. Not all diuretics have this potassium-robbing action; those which don't are known as potassium-sparing diuretics. These drugs in combination with also necessary insulin can bring about a lower than normal potassium level known as hypokalemia. The problem can be prevented or solved by a prescription for a potassium supplement (K-Dur is just one brand name). *Hypertension drugs known generically as Diazoxide (Brand names: Hyperstat, Proglycem) are used not only for cases of high blood pressure, but also for treating non-diabetic hypoglycemia. This class of medication will raise blood glucose levels. The drug Diamox (acetazolamide) shown in the table above can be used to treat glaucoma, seizure disorders as well as some other medical conditions along with heart/hypertension problems. This drug, along with Methazolamide, (Neptazane) dorzolamide, (Trusopt), Brinzolamide (Azopt) and Topiramate are classed as carbonic anhydrase inhibitors, which are capable of causing a loss of blood glucose control and may increase the amount of glucose in the blood and urine of those with diabetes. *'Propanolol' AKA Inderal is a drug used to fight hypertension (high blood pressure) and heart disease in people. The drug belongs to the beta-blocker class. They work by blocking beta receptors in the heart for noradrenaline and adrenaline. Anyone with diabetes using beta-blockers needs to be especially careful, because they also can block some of the normal symptoms of hypoglycemia and may make a hypoglycemic episode last longer. Beta blockers increase the risk of hyperglycemia in those with diabetes. *'Methyldopa', brand name Aldoril, used in treating hypertension. can lower blood glucose levels. *'Verapamil' (Calan, Covera, Isoptin, Veralan) See Contraindications above for Antiarrthymics/Heart/High Blood Pressure. Causes hyperglycemia in dogs--can possibly precipitate a hyperglycemic crisis in canine diabetics. Beta blockers have other uses beyond heart and high blood pressure problems; some are used in the treatment of glaucoma: Timolol AKA (Timoptic), (Betimol) (Isatol) is one. [[:Wikipedia:Betaxolol|'Betaxolol']] AKA Betoptic, Betoptic S, Lokren, Kerlone is another, along with [[:Wikipedia:Carteolol|'Carteolol']] (many brand names at the link), as well as [[:Wikipedia:Levobunolol|'Levobunolol']] (brand names at link), and [[:Wikipedia:Metipranolol|'Metipranlol']] (brand names at link.) Some of these are for use in the eyes but there are oral forms of them for treating glaucoma also. Sedatives, anesthesias, analgesics, emetics Antidepressants and Other Behavior-Modifying Drugs Many of the drugs commonly used for people are used for the same purposes in pets. The following medications have been cited as having possible side effects in persons with diabetes: See Hormones above for information on Medroxyprogesterone acetate, which can also be prescribed for some types of behavioral problems. Warnings: Can Lower Blood Glucose *'Alcohol' can strengthen the blood glucose-lowering effects of insulin. Though our pets don't use alcohol as people do, there are medications and supplements both by prescription and OTC, which contain alcohol as part of their ingredients. Reading labels carefully and being cautious when using meds containing alcohol can prevent possible hypos. *'Metoclopramide, aka Reglan, Clopra, Maxolon, Octamide, Reclomide' is used for GI problems and also to prevent vomiting. "Metoclopramide may accelerate food absorption and thereby alter insulin doses and/or timing of insulin effects." For antibotics and sulfa drugs which lower blood glucose, see Antibiotics section above. All heart/hypertension/diuretics, some of which do lower blood glucose levels are also listed above in their own section. False Testing Results-Urine Glucose Some medications and supplements can cause false negative or false positive results when testing urine for glucose. If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results. False Testing Results-Urine Ketones Some medications and supplements can cause false negative or false positive results when testing urine for ketones. If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results. References More Information *Multidrug Sensitivities in Dogs--How They Can Be Gene-Related VetMed WSU *Commonly Used Veterinary Drugs and Dosages By Species PetTalk *Therapeutic Drug Monitoring--Tailoring Drug Dosages to the Individual Patient Boothe, Dawn Merton, 2003, VetMed Auburn University *Start Page to US Pharmacopeia--Information on Over 9,000 Rx & OTC Drugs *Veterinary Drug Database AnimalHelp *Avoiding Adverse Drug Reactions Trepanier, Lauren, 2001, WSAVA *Various Novo Insulins Novo Nordisk This pdf file contains some information about what medications may interfere with insulin treatment on page 2. *Drugs That Can Worsen Diabetes Control Diabetes Self-Management-April 2009 *Vetsulin-Insulin Requirement Changes in Dogs Intervet *Drug-Induced Disorders of Glucose Tolerance Pandit MK, Burke J, Gustafson AB, Minocha A, Peiris AN., 1993, Annals of Internal Medicine *Cook-Identifying the reasons behind difficult-to-control diabetes in dogs-pages 2-3 Audrey Cook-1 April 2010-DVM 360 *Hormones Which Raise or Lower Blood Glucose Clinical Chemistry Category:Complications Category:Tips Category:Treatments Category:Content Category:Complications Category:Tips Category:Treatments Category:Content Category:Introduction